Kangaroo care

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Hi great ones(everyone is)
I would like to know if you`ve got protocol about Kangaroo care or skin to skin contact(i.e.weight,overall wellness etc.)?Anyone who can recommend a good website about evidence- based KC w/c allows free view of full text apart from Cihnal or Ovid?Thank you in advance for your replies.

We need an order to Kangaroo if the baby has an arterial line. Other than that it's policy that we can initiate based on our assessment of whether the baby is stable enough for it or not. It's usually the nurse's call.

I`m in London,where developmental care nursing is becoming more popular w/c I believe a norm in the US ages ago.Some big hospitals here go to US to have trainings on this issue.I`m interested on KC as part of developmental care.Reading on some articles from Ovid I have noticed that some hospital got policies regarding KC,ie >1.5kg,>28wks aog.It would be nice to have a policy to cover you but I also believe that it should be left on the judgement of the patient health advocate w/c is the nurse.

> 1.5 kg??!!! Wow ! That's pretty big considering we send 'em home at >1900gms! We had a little IUGR 25 weeker who was on nasal cannula and working up on feeds and her mom would Kangaroo her all the time. She was 700 g when we started.Boy, did she take off after that! Was on room air and taking a bottle in a couple of weeks.

Wow! 700gms would be a boarder in NICU until he gain 300gms or more then will be transferred to the adjacent room w/c we call high dependency,in the NICU we ask parents to go out when another sick baby need x-ray or when we are going to change shift so (?)not conducive for kangarooing because of frequent disturbance.You`ve really come a long way, I hope we can catch up with you soon because it`s fab for the wellbeing of this little angels and their parents.

-Stable premies and full-term infants(not trouble with BP, cardiac stuff like PDA, no siezures, no CT's, no umbilical lines, no intubated babes)
-Stable oxygen needs(FiO2 needs .21 to .25 or nasal can. 1/16 to 1/2L....EXCEPT BPD kids, then they need to be consistenly be in l0w .30's.
-Resp. Support: NCPAP 5, 4, or 3; Nasal Can; or hood O2. We do not take NCPAP off unless babes are on trials.
-IV's: ok with....CVC, PIV but no with PAL or umbilical lines
-Length of first Kangaroo experience is 1 hour...then advance to 1 hour bid or 1 2 hour session, 1 hour tid or two 2 hour sessions
-No K-Care if has A&B x 5/day requirering stim. ( self limited do not count)
-Premies 22 to 25 weeks can K-Care if they are 30 days old. Weight is not a factor...but baby must have stable temp.

We also made up a pamphlet for parents and they watch a video before they start. We try to have parents do this durring the babe's quiet hour.

A lot of times, A's and B's are caused by reflux. When babies are held semi-upright on Mom or Dad's chest, they reflux less. Also, parents can be taught to respond to an A&B, i.e., stimulate the baby, call the nurse, etc. For some [more obstinate] kiddos, waiting till 5 days w/o A&B's might mean somewhere around potty training time..... Yes, you know the premies I'm talking about!

Actually it's not at potty training time....I'm talking about sign. A&B's more than reflux which is ussually self-limited. We generally extubate our babe early than most hospitals too....ussually in the first or second week on micro premies. Most of the kids on full feeds who have reflux have been on KCare a long time already.

All I can say is we've had great success and that speaks for it's self I think. The main thing when setting up a policy get Everyone involved....doctors, nurses, RT's....Everyone!

I`ve got this baby,doing very well onKC,no A&B for a week then suddenly loads of A&B+desats needing vigorous stimulation,long line sepsis was the culprit.parents extremely anxious coz they thought baby will not go downhill again,I was wondering shall I or shall I not encourage KC?My own criteria for KC is they should be relaxed so as not to give negative stimulation for the baby.

Unfortunately, having a baby in a NICU is a roller-coaster ride. Babies can get septic @ any time, up to and including the day of discharge. Once the baby is again stable, and meets the criteria in your unit for Kangaroo Care, you can again offer it to the parents. Even if they don't want to do that, they can still hold the baby.

I'd expect them to be nervous, but you can remind them that it's not their fault, just like the fact that the baby is in the NICU in the 1st place isn't their fault. If they just happen to come in when YOU are holding the baby, they will feel more comfortable--don't forget-you are modeling behavior for them.